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General NPI Number Information
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NPI Number | 1285491951
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Entity Type | Organization
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Legal Business Name | TIDEWATER SUPERIOR HOME SUPPORT LLC
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Dates
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Enumeration Date | 02/29/2024
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 500 E MAIN ST # 1545
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City | NORFOLK
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State | VA
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Zip | 23510-2205
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Country | US
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Telephone | 757-802-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E MAIN ST # 1600-7
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City | NORFOLK
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State | VA
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Zip | 23510-2205
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Country | US
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Telephone | 757-802-7600
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. DERRICK SAUNDERS
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Credential |
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Telephone | 757-802-7600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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